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Published on: August 8, 2022
Sarcoidosis Masquerading as Hypertrophic Cardiomyopathy
Sanjay Sivalokanathan1, Sharan J Kapadia1, Philip Robson1
1Mount Sinai, New York, New York, USA.
Insights
Cardiac sarcoidosis can mimic hypertrophic cardiomyopathy (HCM), leading to syncope. Combined PET/MR imaging is crucial for accurate diagnosis and distinguishing these conditions.
Area of Science:
- Cardiology
- Advanced Cardiac Imaging
- Immunology
Background:
- Hypertrophic cardiomyopathy (HCM) and infiltrative cardiomyopathies are significant causes of cardiogenic syncope.
- These conditions often present with overlapping clinical and radiologic features, complicating diagnosis.
Background:
Hypertrophic cardiomyopathy (HCM) and infiltrative cardiomyopathies are important causes of cardiogenic syncope with overlapping clinical and radiologic features.
Case Summary:
A 49-year-old gentleman presented with syncope while walking across the Brooklyn Bridge. Electrocardiogram revealed low-voltage QRS with diffuse T-wave inversions. Echocardiography revealed moderate left ventricular hypertrophy, wall motion abnormalities with left ventricular ejection fraction 35% to 40%, and a dilated, hypokinetic right ventricle. Cardiac magnetic resonance showed biventricular hypertrophy and evidence of late gadolinium enhancement. Positron emission tomography/magnetic resonance (PET/MR) 18F-FDG revealed right ventricle uptake along with matching late gadolinium enhancement and FDG avidity in the hilar and mediastinal lymph nodes. Endomyocardial biopsy showed noncaseating granulomas, confirming sarcoidosis. An implantable cardioverter-defibrillator was inserted. Despite immunosuppression and guideline-directed medical treatment, the patient eventually required cardiac transplantation.
Discussion:
Cardiac sarcoidosis mimicking genetic cardiomyopathy, and vice versa, has often been reported. Combined PET/MR helped distinguish these pathologies in our patient.
Take-Home Messages:
Cardiac sarcoidosis can mimic HCM; multimodal imaging, including PET/MR, guided by clinical suspicion, is important. Biventricular involvement in HCM is infrequent.
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